Afford Health Care Research Articles

Poverty as a Hindrance to Accessing Quality Healthcare in Ghana: A Theological and Pastoral Reflection

Access to quality healthcare is a key requirement in every modern society. In developed countries, majority of the populace has access to quality and affordable healthcare. However, in developing countries such as Ghana, hospitals with quality infrastructure, healthcare equipment, drugs, and well-trained health practitioners are limited and expensive to access. Given the significant number of people living in extreme poverty in Ghana, it is not surprising that many people experience deterioration in their health and eventually die due to the inability to access and/or afford quality healthcare. In the current situation, where economic hardship keeps increasing in the country, there is a need to engage in a discussion on how healthcare can be made available and affordable to people of all economic classes. The purpose of this paper, therefore, is to assess the limitations that poverty places on people in their quest to access healthcare and offer solutions from theological and pastoral perspectives. This paper employed qualitative and historical descriptive research designs to describe the current state of affairs of the impact that poverty has on access to health care in Ghana. The paper used data collected from secondary sources such as books, journal articles and dissertations. After a careful analysis of the subject matter from the Ghanaian and biblical perspectives, the paper made recommendations for the nation (Ghana), the church, and all stakeholders to contribute to the provision of quality, accessible, and affordable healthcare for all irrespective of one’s financial background or economic status. Keywords: Poverty, Hindrance, Quality Health, Ghana

Managing Constraints: A Method To Improve The Accessibility And Quality Of A Brazilian Public Emergency Hospital

Accessibility to public hospitals in Brazil is a serious problem and there is much to be done to improve the quality of care. The private care system is expensive and only a small percentage of the population can afford health care. The consequence is that most emergency hospitals are constantly overcrowded. Patients must wait to start treatment and delays can lead to an increased risk of sequelae or even represent the difference between life and death. Reducing waiting times for treatment is considered an important measure to control costs and improve service efficiency. The objective of this article is to present a method that aims to improve the access and quality of the emergency hospitalization system of a municipal public hospital in the State of Rio de Janeiro, Brazil. The method is based on the authors' experience in health services operational research and combines the theory of constraints and discrete event simulation. It is hoped that this article will contribute to administrative knowledge and the results can be implemented in other national public hospitals

Physical Pain Among Urban Native American Emerging Adults: Sociocultural Risk and Protective Factors.

American Indian/Alaska Native (AI/AN) people have high rates of physical pain. Pain is understudied in urban-dwelling, AI/AN emerging adults, a group with unique sociocultural risk and protective factors. We explore associations between socioeconomic disadvantage, additional sociocultural factors, and pain among urban AI/AN emerging adults. AI/AN participants aged 18-25 years ( N = 417) were recruited via social media. Regression models tested associations between socioeconomic disadvantage (income and ability to afford health care) and pain as well as additional sociocultural factors (discrimination, historical loss, cultural pride and belonging, visiting tribal lands) and pain. Multigroup regression models tested whether associations between sociocultural factors and pain differed between participants who were socioeconomically disadvantaged and those who were less disadvantaged. In the full sample, lower income ( b = 1.00-1.48, p < .05), inability to afford health care ( b = 1.00, p = .011), discrimination ( b = 0.12, p = .001), and historical loss ( b = 0.24, p = .006) were positively associated with pain, whereas visiting tribal lands was negatively associated with pain ( b = -0.86 to -0.42, p < .05). In the multigroup model, visiting tribal lands 31+ days was negatively associated with pain only among the less socioeconomically disadvantaged group ( b = -1.48, p < .001). Socioeconomic disadvantage may, in part, drive pain disparities among AI/AN emerging adults and act as a barrier to benefitting from visiting tribal lands. Results support a biopsychosocial approach to targeting pain in this population, including addressing socioeconomic challenges and developing culturally informed, strengths-based interventions.

Evaluation of a comprehensive health check offered to frontline health workers in Zimbabwe.

Health workers are essential for a functioning healthcare system, and their own health is often not addressed. During the COVID-19 pandemic health workers were at high risk of SARS-CoV-2 infection whilst coping with increased healthcare demand. Here we report the development, implementation, and uptake of an integrated health check combining SARS-CoV-2 testing with screening for other communicable and non-communicable diseases for health workers in Zimbabwe during the COVID-19 pandemic. Health checks were offered to health workers in public and private health facilities from July 2020 to June 2022. Data on the number of health workers accessing the service and yield of screening was collected. Workshops and in-depth interviews were conducted to explore the perceptions and experiences of clients and service providers. 6598 health workers across 48 health facilities accessed the service. Among those reached, 5215 (79%) were women, the median age was 37 (IQR: 29-44) years and the largest proportion were nurses (n = 2092, 32%). 149 (2.3%) healthcare workers tested positive for SARS-CoV-2. Uptake of screening services was almost 100% for all screened conditions except HIV. The most common conditions detected through screening were elevated blood pressure (n = 1249; 19%), elevated HbA1c (n = 428; 7.7%) and common mental disorder (n = 645; 9.8%). Process evaluation showed high acceptability of the service. Key enablers for health workers accessing the service included free and comprehensive service provision, and availability of reliable point-of-care screening methods. Implementation of a comprehensive health check for health workers was feasible, acceptable, and effective, even during a pandemic. Conventional occupational health programmes focus on infectious diseases. In a society where even health workers cannot afford health care, free comprehensive occupational health services may address unmet needs in prevention, diagnosis, and treatment for chronic non-communicable conditions.

People living with HIV who inject or have injected non-prescription drugs: Evidence of substantial differences in health inequalities and experiences of clinical care.

This study investigates differences in health and well-being associated with current, past or no injecting drug use (IDU) among people living with HIV (PLHIV) in Australia, identifying key health care considerations between injecting experiences. Data were extracted from the HIV Futures 9 study; a survey of PLHIV conducted in 2018-2019. Chi-square and analysis of variance analyses compared clinical and treatment characteristics, major physical and mental comorbidities, sexually transmitted infection diagnoses, and quality of life for those who reported current (last 12 months), past (12+ months ago) or no IDU. Current IDU (n = 106) was associated with higher rates of sexually transmitted infection testing and diagnoses, higher frequency of self-reported antiretroviral therapy non-adherence due to drug use and greater social quality of life than past (n = 126) or no IDU (n = 508; total N = 740). Past and current IDUs were associated with more mental illness diagnoses and self-reported concern about drug use. Past IDU was associated with more physical comorbidities, lower satisfaction with clinical care and greater difficulty in affording health care than current or no IDU. Past and current IDUs are associated with unique health concerns. However, past IDU appears to be related to greater dissatisfaction in navigating health care than individuals with current IDU experience. Higher social connection and the types of services being accessed by individuals who currently inject may play a role in shaping service satisfaction. Peer-based interventions to help support individuals in accessing services that are affirming of their needs is an ongoing priority.

The role of multidimensional poverty in antibiotic misuse: a mixed-methods study of self-medication and non-adherence in Kenya, Tanzania, and Uganda

Poverty is a proposed driver of antimicrobial resistance, influencing inappropriate antibiotic use in low-income and middle-income countries (LMICs). However, at subnational levels, studies investigating multidimensional poverty and antibiotic misuse are sparse, and the results are inconsistent. We aimed to investigate the relationship between multidimensional poverty and antibiotic use in patient populations in Kenya, Tanzania, and Uganda. In this mixed-methods study, the Holistic Approach to Unravelling Antimicrobial Resistance (HATUA) Consortium collected data from 6827 outpatients (aged 18 years and older, or aged 14-18 years and pregnant) with urinary tract infection (UTI) symptoms in health-care facilities in Kenya, Tanzania, and Uganda. We used Bayesian hierarchical modelling to investigate the association between multidimensional poverty and self-reported antibiotic self-medication and non-adherence (ie, skipping a dose and not completing the course). We analysed linked qualitative in-depth patient interviews and unlinked focus-group discussions with community members. Between Feb 10, 2019, and Sept 10, 2020, we collected data on 6827 outpatients, of whom 6345 patients had complete data; most individuals were female (5034 [79·2%]), younger than 35 years (3840 [60·5%]), worked in informal employment (2621 [41·3%]), and had primary-level education (2488 [39·2%]). Antibiotic misuse was more common among those least deprived, and lowest among those living in severe multidimensional poverty. Regardless of poverty status, difficulties in affording health care, and more familiarity with antibiotics, were related to more antibiotic misuse. Qualitative data from linked qualitative in-depth patient interviews (n=82) and unlinked focus-group discussions with community members (n=44 groups) suggested that self-medication and treatment non-adherence were driven by perceived inconvenience of the health-care system, financial barriers, and ease of unregulated antibiotic access. We should not assume that higher deprivation drives antibiotic misuse. Structural barriers such as inefficiencies in public health care, combined with time and financial constraints, fuel alternative antibiotic access points and treatment non-adherence across all levels of deprivation. In designing interventions to reduce antibiotic misuse and address antimicrobial resistance, greater attention is required to these structural barriers that discourage optimal antibiotic use at all levels of the socioeconomic hierarchy in LMICs. UK National Institute for Health Research, UK Medical Research Council, and the Department of Health and Social Care.

Eclampsia a preventable tragedy: an African overview.

Eclampsia is a multisystemic disease associated with various complications which individually or in combination can lead to maternal/fetal morbidity and mortality. Developed countries and some developing countries were largely successful in reducing the incidence of eclampsia. Developing countries especially those in Sub-Saharan Africa (SSA) are still dealing with high incidence of eclampsia. The question is why have the incidence and mortality of eclampsia remained high in SSA? The risk factors for this disease are globally the same but a critical assessment showed that there are certain risk factors thatare common in Sub-Saharan Africa (multiple pregnancy, sickle cell disease, pregnancies at the extremes of reproductive age, pre-existing vasculitis). In addition, there are compounding factors (illiteracy, poverty, superstitious beliefs, poor prenatal care services, poorly trained manpower and lack of facilities to cater for patients). Addressing the menace of this disease require a holistic approach which among others, includes education to address beliefs and reduce harmful practices, poverty alleviation which will improve the ability for communities to afford health care services. Improving transport services to convey patients quickly to facilities on time when there is need. Improving the health infrastructure, building more facilities, providing trained and motivated manpower and regular supply of quality essential drugs for the management of the disease. This review is meant to analyze factors prevalent in Sub-Saharan that hinder reducing incidence of the disease and provide comprehensive and cost-effective solutions.

MP26-15 RURAL HOSPITAL LOCATION IS ASSOCIATED WITH HIGHER REPORTED PRICES FOR URETEROSCOPY WITH LASER LITHOTRIPSY AMONG COMMERCIALLY INSURED PATIENTS

You have accessJournal of UrologyCME1 May 2022MP26-15 RURAL HOSPITAL LOCATION IS ASSOCIATED WITH HIGHER REPORTED PRICES FOR URETEROSCOPY WITH LASER LITHOTRIPSY AMONG COMMERCIALLY INSURED PATIENTS Ian Berger, Vishnukamal Golla, Marcelo Cerullo, Yuqi Zhang, Michael E. Lipkin, Gary J. Faerber, Deborah R. Kaye, and Charles D. Scales Ian BergerIan Berger More articles by this author , Vishnukamal GollaVishnukamal Golla More articles by this author , Marcelo CerulloMarcelo Cerullo More articles by this author , Yuqi ZhangYuqi Zhang More articles by this author , Michael E. LipkinMichael E. Lipkin More articles by this author , Gary J. FaerberGary J. Faerber More articles by this author , Deborah R. KayeDeborah R. Kaye More articles by this author , and Charles D. ScalesCharles D. Scales More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002569.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Price negotiation between hospitals and insurers is influenced by market competition factors. For rural hospitals, decreased inter-hospital competition may favor hospital negotiating power. However, price differences between rural and metropolitan hospitals for urologic surgeries have not been studied. Our objective was to evaluate prices for ureteroscopy with laser lithotripsy (URS) between rural and metropolitan hospitals in the context of urologist density. METHODS: The Turquoise Health Price Transparency dataset contains publicly available prices from reporting hospitals. We abstracted prices for commercial payers for URS (CPT 52356). We averaged prices across payers by hospital. County level urologist and population density were obtained from the 2019 Area Health Resource File and aggregated into Health Service Areas (HSA) defined by the National Center of Health Statistics. Rural-Urban Commuting Area (RUCA) codes were used to classify each hospital as rural versus metropolitan. Facility features were obtained from the 2019 Centers for Medicare and Medicaid Services Healthcare Cost Reporting Information System and Wage Index. A generalized linear model with gamma distribution and log link evaluated the association of mean price of URS with RUCA classification, controlling for urologist density and facility features. RESULTS: A total of 659 hospitals reported prices for URS with a median rate of $6,161 (interquartile range $3,836 – $10,338). Rural hospitals comprised 24% (158/659) of facilities. Among HSA with a hospital reporting a URS price, 25th percentile of urologist density was 1.6 per 100,000 persons, 50th was 2.5, and 75th was 3.6. Controlling for hospital factors and urologist density, the price for URS was 26% higher (p=0.004) at rural versus metropolitan hospitals and for profit hospital price was 34% higher versus non-profit (p<0.001) [Table 1]. Price was 32% lower in the Northeast compared to West region (p<0.001). CONCLUSIONS: URS prices are higher at rural hospitals. Rural hospitals may face decreased competition for negotiating prices with insurance companies. Higher prices in these areas may exacerbate disparities for rural patients who may struggle to afford health care. Source of Funding: Duke University Bass Connections © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e445 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ian Berger More articles by this author Vishnukamal Golla More articles by this author Marcelo Cerullo More articles by this author Yuqi Zhang More articles by this author Michael E. Lipkin More articles by this author Gary J. Faerber More articles by this author Deborah R. Kaye More articles by this author Charles D. Scales More articles by this author Expand All Advertisement PDF DownloadLoading ...

The enduring consequences of conflict-related sexual violence: a qualitative study of women survivors in northern Uganda

BackgroundOne in three women in northern Uganda report having suffered from conflict-related sexual violence (CRSV), including forced marriage and rape. Research on the long-term effects of CRSV on the health and social well-being of survivors is scant, but crucial to informing policy and improving programs tailored to conflict-affected communities. Understanding women’s perceptions of and experiences with CRSV, especially related to the persistent health and social challenges they continue to face, is critical for developing effective and targeted interventions.MethodsWe worked with a local, survivor-led organization to recruit participants purposively from three post-conflict districts in northern Uganda: Gulu, Lira, and Pader. Women who had experienced CRSV and who were 18 years of age or older were eligible to participate. We asked participants open-ended questions about their experience with CRSV, including how it continues to affect their health and social well-being, any impact it had on their relationships, and if they faced barriers to accessing services. We transcribed, translated, and uploaded interview responses to the qualitative data analysis software MAXQDA and analyzed data thematically using a modified approach to grounded theory.ResultsWe conducted 30 interviews between October 2016 and March 2017. All participants reported experiencing forced marriage, rape, or forced pregnancy. Over two-thirds of participants said they continued to face physical and psychological issues, including untreated sexually transmitted infections, anxiety, and depression. Almost half of the women faced challenges with maintaining links with family members, stigma related to their experiences during abduction that also extended to their children born in captivity, and difficulty with accessing and affording health care. Barriers to seeking care included fear of disclosure and being unable to find services. Women identified peer-support from other survivors as a key coping mechanism.ConclusionsWomen survivors continue to face multifaceted health and social problems in the post-conflict period. Most health-related programs that were set up at the end of the war in northern Uganda are no longer available. Increasing access to care, particularly services tailored to treating chronic reproductive health issues and mental health, is paramount for women survivors in northern Uganda and other conflict-affected regions.

Adverse childhood experiences, diabetes and associated conditions, preventive care practices and health care access: A population-based study

Our objective was to examine how Adverse Childhood Experiences (ACEs) are associated with diabetes mellitus, diabetes-related conditions, and preventive care practices. We used data from the Behavioral Risk Factor Surveillance System (BRFSS) 2009–2012, a cross-sectional, population-based survey, to assess ACEs, diabetes, and health care access in 179,375 adults. In those with diabetes (n = 21,007), we assessed the association of ACEs with myocardial infarction, stroke, and five Healthy People 2020 (HP2020) diabetes-related preventive-care objectives (n = 13,152). Healthcare access indicators included lack of a regular health care provider, insurance, and difficulty affording health care. Regression analyses adjusted for age, sex, and race. The adjusted odds ratio (AOR) of diabetes increased in a stepwise fashion by ACE exposure, ranging from 1.2 (95% CI 1.1–1.3) for 1 ACE to 1.7 (95% CI 1.6–1.9) for ≥4 ACEs, versus having no ACEs. In persons with diabetes, those with ≥4 ACEs had an elevated adjusted odds of myocardial infarction (AOR = 1.6, 95% CI 1.2–2.0) and stroke (AOR = 1.8, 95% CI 1.3–2.4), versus having no ACEs. ACEs were also associated with a reduction in the adjusted percent of HP2020 diabetes objectives met: 72.9% (95% CI 71.3–74.5) for those with no ACEs versus only 66.5% (95% CI 63.8–69.3%) for those with ≥4 ACEs (p = 0.0002). Finally, ACEs predicted worse health care access in a stepwise fashion for all indicators. In conclusion, ACEs are associated with greater prevalence of diabetes and associated disease conditions, and with meeting fewer HP2020 prevention goals. Implementing ACE screening and trauma-informed health care practices are thus recommended.

The Work of Pharmaceuticals in Austerity-Burdened Athens. Modes and Practices of Care in Times of Crisis

ABSTRACT Based on ethnographic fieldwork carried out in a social clinic of solidarity on the outskirts of Athens, the article explores how modes and values of care are constantly reconfigured at the intersection of an ever-expanding grassroots voluntary medical sector, the state and the household in a moment of severe economic distress. It traces the changing relations of care across these three realms where diverse modes of care have traditionally unfolded. In suggesting that pharmaceuticals have become increasingly crucial to social, economic and political relations amongst citizens who can no longer afford health care, I show how in the Athenian context, the circulation, sharing and exchanging of pharmaceuticals reinforce collective social bonds and argue that domestic modes of care (frontida) have increasingly been informed by biomedical modes of care (iatriki perithalpsi) stemming from the intermittent availability and unavailability of pharmaceutical drugs.

The Lancet Commission on cancer and health systems: harnessing synergies to achieve solutions

The Lancet Commission on cancer and health systems: harnessing synergies to achieve solutions

Blood and Marrow Transplant Clinical Trials Network Study 1102 heralds a new era in hematopoietic cell transplantation in high-risk myelodysplastic syndromes: Challenges and opportunities in implementation.

People who have advanced myelodysplastic syndromes (MDS) may live longer if they get a bone marrow transplant (BMT) instead of other therapies. However, only 15% of people with MDS actually get BMT. Experts say community physicians and transplant physicians should team up with insurance companies and patient advocacy groups to 1) spread this news about lifesaving advances in BMT, 2) ensure that everyone can afford health care, 3) provide emotional support for patients and families, 4) help patients and families get transportation and housing if they need to travel for transplant, and 5) improve care for people of under-represented racial and ethnic backgrounds.

Investigating unmet need for healthcare using the European Health Interview Survey: a cross-sectional survey study of Luxembourg

ObjectivesWe investigate the prevalence of unmet need arising from wait times, distance/transportation and financial affordability using the European Health Interview Survey. We explore associations between individual characteristics and the probability...

Insult to injury: National analysis of return to work and financial outcomes of trauma patients.

While much of trauma care is rightly focused on improving inpatient survival, the ultimate goal of recovery is to help patients return to their daily lives after injury. Although the overwhelming majority of trauma patients in the United States survive to hospital discharge, little is known nationally regarding the postdischarge economic burden of injuries among trauma survivors. We used the National Health Interview Survey from 2008 to 2017 to identify working-age trauma patients, aged 18 to 64 years, who sustained injuries requiring hospitalization. We used propensity score matching to identify noninjured respondents. Our primary outcome measure was postinjury return to work among trauma patients. Our secondary outcomes included measures of food insecurity, medical debt, accessibility and affordability of health care, and disability. A nationally weighted sample of 319,580 working-age trauma patients were identified. Of these patients, 51.7% were employed at the time of injury, and 58.9% of them had returned to work at the time of interview, at a median of 47 days postdischarge. Higher rates of returning to work were associated with shorter length of hospital stay, higher education level, and private health insurance. Injury was associated with food insecurity at an adjusted odds ratio (aOR) of 1.8 (95% confidence interval, 1.40-2.37), with difficulty affording health care at aOR of 1.6 (1.00-2.47), with medical debt at aOR of 2.6 (2.11-3.20), and with foregoing care due to cost at aOR of 2.0 (1.52-2.63). Working-age trauma patients had disability at an aOR of 17.6 (12.93-24.05). The postdischarge burden of injury among working-age US trauma survivors is profound-patients report significant limitations in employment, financial security, disability, and functional independence. A better understanding of the long-term impact of injury is necessary to design the interventions needed to optimize postinjury recovery so that trauma survivors can lead productive and fulfilling lives after injury. Economic & Value-Based Evaluations, level II; Prognostic, level II.

Teacher's Job Satisfaction at Tertiary Level in district Swabi

The current study focused on tertiary level teacher job satisfaction. The study's goal was to find out how instructors felt about their jobs in terms of pay and working conditions. The available population consisted of all of the teachers from the five colleges within the University of Swabi's jurisdiction. A convenient sample of 36 female lecturers from five public sector institutions was chosen from the entire population. With the help of my supervisor, I created a closed end questionnaire with 15 items on a likert scale (very satisfied, satisfied, neutral, dissatisfied, and severely unhappy). According to the study's findings, half of the respondents were satisfied with the salary they received from their institution. The vast majority of respondents felt that their salaries met their fundamental needs. Half of the respondents were unsatisfied with their pay since it was insufficient to cover their children's educational costs. Half of the respondents were unsatisfied with their pay, believing that it was insufficient to afford health care for their family. Based on the findings, it was suggested that the instructor devote all of their efforts to enhance the teaching-learning process.

Why Employment During and After COVID-19 Is a Critical Women's Health Issue.

Why Employment During and After COVID-19 Is a Critical Women's Health Issue.

Lifetime Prevalence and Correlates of Patient-Perceived Medical Errors Experienced in the U.S. Ambulatory Setting: A Population-Based Study.

Background: The rate of safety harm self-perceived medical errors and harms reported in the U.S. ambulatory system is not well characterized.Objectives: To determine the prevalence of U.S. adult ambulatory care patient self-perceived safety harms and to gauge the degree of association between harms with various patient characteristics and outcomes.Methods: A large U.S. cross-sectional online survey of 9206 ambulatory care adults was assessed for their perception of medical errors and harms during care (misdiagnosis, mistakes in care, and wrong or delayed treatment) and also included patient demographics, health status, comorbidities, insurance status, income, barriers to care (affordability, transportation, and family and social support), number of visits to primary health care services in the past 12 months, and use of urgent or emergency care in the last 12 months.Results: The overall rate of self-perceived medical errors and harms among adult patients in the ambulatory care setting was 36%. Female patients, independent of age, and those with multiple comorbidities or barriers to care, reported the highest number of medical errors. Utilization of multiple providers was associated with a greater number of reported medical errors, often resulting in changing health care providers. Patients who reported having trouble affording health care or navigating the system to receive care also reported higher levels of harm. They were cared for by multiple providers, often switch providers, and their care is associated with greater utilization of health care resources. Patients reporting the highest rates of harm had greater use of hospital and emergency room care.Conclusions: This large U.S. adult ambulatory care study provides evidence that patient self-perceived medical errors and harms reported by patients are common. Patient self-perceived medical errors and harms occur most commonly in women, with poor health, limitation of activities, and who have three or more comorbidities.

Supplemental Nutrition Assistance Program Participation Improves Children's Health Care Use: An Analysis of the American Recovery and Reinvestment Act's Natural Experiment.

To examine the impact of increased Supplemental Nutrition Assistance Program (SNAP) benefit levels as provided by the American Recovery and Reinvestment Act (ARRA) beginning in April 2009 on the health care use and health care needs of participating children. Difference-in-differences analysis compared changes in health care use and needs between children in SNAP-eligible households and those in low-income but SNAP-ineligible households before and after ARRA's implementation, using data from the nationally representative National Health Interview Survey (NHIS). Survey respondents reported on children's health care use and outstanding health care needs. Our sample included approximately 38,500 children in low-income households who completed the core NHIS, and a subsample of 15,000 sample children who reported additional information. Approximately 6% of low-income children had delayed care due to cost. Three percent and 4% of children in low-income households and low-income single-parent households, respectively, reported needing health care but not being able to afford it. The increase in SNAP benefits was associated with a 65% reduction in outstanding medication needs due to affordability among SNAP-eligible children, relative to low-income, ineligible children. There was also a reduction in the likelihood that children had seen a general doctor in the last year. Among children in single-parent households, SNAP benefit expansion was associated with a 3.2 percentage point decrease in needing but not being able to afford health care. Findings suggest that even a small increase in household resources leads to reductions in outstanding health care needs due to affordability, particularly among children.

Assessing Worry About Affording Healthcare in a General Population Sample.

This study adapted a measure on worry about affording healthcare. The financial costs of healthcare are increasingly being shifted to patients. Financial burden from healthcare costs can be material (such as bankruptcy) or psychological. Psychological distress can be either worry about affording future care or distress due to material consequences and, despite evidence from clinical psychology that differentiates these types of emotional symptoms, this distinction has largely been ignored for financial burden in healthcare. We adapted a worry about affording healthcare scale for use in the general population (n = 398) to facilitate comparisons between disease groups and across countries. Participants completed a survey through an online platform. The worry about affording healthcare measure showed good reliability and validity through associations with quality of life (QOL) and measures of other types of financial burden. Worry about affording healthcare was also associated with cost-related non-adherence to medical care. Future research on patient QOL should consider worry about affording healthcare.